A STUDY TO CORRELATE ANTERIOR NECK SOFT TISSUE THICKNESS QUANTIFIED USING ULTRASOUND AND MODIFIED MALLAMPATTI SCORE FOR PREDICTING DIFFICULT LARYNGOSCOPY.
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Keywords
Ultrasound, anterior neck soft tissue thickness, modified mallampatti score, difficult laryngoscopy, BMI.
Abstract
BACKGROUND AND AIMS:
Unanticipated difficult intubation remains a primary concern for anaesthesiologists. This study aims to correlate anterior neck soft tissue thickness quantified using ultrasound and Modified Mallampati score for predicting difficult laryngoscopy.
METHODS:This was a cross-sectional study conducted at BMC hospital from November 2018 to May 2020. This study aimed to evaluate the predictive ability of the Modified Mallampati Score (MMS) and anterior neck soft tissue thickness, measured by ultrasound, for difficult laryngoscopy in ASA Grade 1 and 2 adults undergoing elective surgery with general anaesthesia. Neck soft tissue thickness was measured at the hyoid bone, thyrohyoid membrane, and anterior commissure. Laryngoscopic views were classified using Cormack and Lehane. The study compared MMS and ultrasound measurements to identify the better predictor of difficult laryngoscopy
RESULTS:
Out of 210 cases, 74 (35.2%) were classified as difficult laryngoscopy. BMI, neck circumference, DSHB, DSEM, and DSAC were significantly higher in this group. Strong (r = 0.642), moderate (r = 0.435), and small (r = 0.256) positive correlations were observed between DSEM-DSAC, DSHB-DSAC, and DSHB-DSEM, respectively, all statistically significant (p < 0.001).
Compared to other airway assessment parameters, the Mallampati score showed low sensitivity, specificity, and the smallest AUC. Ultrasound-measured anterior neck soft tissue thickness was a more reliable predictor of difficult laryngoscopy.
CONCLUSION:
The anterior neck soft tissue thickness quantified using ultrasound is a good predictor of difficult laryngoscopy in addition to the conventional methods of assessing difficult airway.
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Dr. Soumya Rohit
Assistant Professor, BMCRI Bangalore
Dr. Thanuja N Umesh
Senior Resident, department of critical care medicine, St Johns medical college and hospital, Bangalore.